Provider Demographics
NPI:1346532074
Name:STETZER, ELIZABETH S (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:STETZER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SNELLINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7900
Mailing Address - Fax:757-446-7464
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7900
Practice Address - Fax:757-446-7464
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003627363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherMULTIPLAN
VA-010OtherTRICARE/CHAMPUS
NC8101073Medicaid
VAPAROtherCORVEL
VA10078674POtherOPTIMA HEALTH
VA1346532074Medicaid
VAPAROtherUSA MANAGED CARE
NC8101073Medicaid